Climate change: the public health response

Wider action plan and multidisciplinar approach could be a wining idea in creation of friendly environment

Herein, we proposed planning of wide transdisciplinary actions, which bring a solution for economic activity such as transportation, strongly related to pollution output with possible repercussions on climate change and public health. To solve logistics problem by introduction of common intermodal policy, and creation of more friendly transport solution, it is possible to obtain sustainable development, climate change prevention, government policy, and regulation which are all related to human health and creation of health-supportive environment. This approach permits environmental and biological monitoring same as economic results measurement by key performance indicators. This approach implementing emerging scientific knowledge in environmental health science such as genetic epidemiology aimed at understanding how genomic variation impacts phenotypic expression and how genes interact with the environment at the population level with subsequent translation into practical information for clinicians as well as for public health policy creation.

Integrating climate change adaptation into public health practice: using adaptive management to increase adaptive capacity and build resilience

BACKGROUND

Climate change is expected to have a range of health impacts, some of which are already apparent. Public health adaptation is imperative, but there has been little discussion of how to increase adaptive capacity and resilience in public health systems.

OBJECTIVES

We explored possible explanations for the lack of work on adaptive capacity, outline climate-health challenges that may lie outside public health's coping range, and consider changes in practice that could increase public health's adaptive capacity.

METHODS

We conducted a substantive, interdisciplinary literature review focused on climate change adaptation in public health, social learning, and management of socioeconomic systems exhibiting dynamic complexity.

DISCUSSION

There are two competing views of how public health should engage climate change adaptation. Perspectives differ on whether climate change will primarily amplify existing hazards, requiring enhancement of existing public health functions, or present categorically distinct threats requiring innovative management strategies. In some contexts, distinctly climate-sensitive health threats may overwhelm public health's adaptive capacity. Addressing these threats will require increased emphasis on institutional learning, innovative management strategies, and new and improved tools. Adaptive management, an iterative framework that embraces uncertainty, uses modeling, and integrates learning, may be a useful approach. We illustrate its application to extreme heat in an urban setting.

CONCLUSIONS

Increasing public health capacity will be necessary for certain climate-health threats. Focusing efforts to increase adaptive capacity in specific areas, promoting institutional learning, embracing adaptive management, and developing tools to facilitate these processes are important priorities and can improve the resilience of local public health systems to climate change.

Information Seeking about Global Climate Change among Adolescents: The Role of Risk Perceptions, Efficacy Beliefs and Parental Influences

Global climate change is likely to have significant impacts on public health. Effective communication is critical to informing public decision making and behavior to mitigate climate change. An effective method of audience segmentation, the risk perception attitude (RPA) framework has been previously tested with other health behaviors and classifies people into 4 groups on the basis of their perceptions of risk and beliefs about personal efficacy. The 4 groups - indifference (low risk, weak efficacy), proactive (low risk, strong efficacy), avoidance (high risk, weak efficacy), and responsive (high risk, strong efficacy) - are hypothesized to differ in their self-protective behaviors and in their motivations to seek information. In this paper, we extend the RPA framework in two ways. First, we use it at the household level to determine whether parental classifications into the 4 groups are associated with their teenage children's classification into the same 4 groups. Second, we predict adolescent information-seeking behaviors on the basis of their and their parents' membership in the 4 RPA groups. Results (N = 523 parent-adolescent pairs) indicated that parental membership in the 4 RPA groups was significantly associated with children's membership in the same 4 groups. Furthermore, the RPA framework was a significant predictor of adolescent information-seeking: those in the responsive and avoidance groups sought more information on climate change than the indifference group. Family communication on global warming was positively associated with adolescents' information-seeking. Implications for interventions are discussed.

Information Seeking about Global Climate Change among Adolescents: The Role of Risk Perceptions, Efficacy Beliefs and Parental Influences

Global climate change is likely to have significant impacts on public health. Effective communication is critical to informing public decision making and behavior to mitigate climate change. An effective method of audience segmentation, the risk perception attitude (RPA) framework has been previously tested with other health behaviors and classifies people into 4 groups on the basis of their perceptions of risk and beliefs about personal efficacy. The 4 groups - indifference (low risk, weak efficacy), proactive (low risk, strong efficacy), avoidance (high risk, weak efficacy), and responsive (high risk, strong efficacy) - are hypothesized to differ in their self-protective behaviors and in their motivations to seek information. In this paper, we extend the RPA framework in two ways. First, we use it at the household level to determine whether parental classifications into the 4 groups are associated with their teenage children's classification into the same 4 groups. Second, we predict adolescent information-seeking behaviors on the basis of their and their parents' membership in the 4 RPA groups. Results (N = 523 parent-adolescent pairs) indicated that parental membership in the 4 RPA groups was significantly associated with children's membership in the same 4 groups. Furthermore, the RPA framework was a significant predictor of adolescent information-seeking: those in the responsive and avoidance groups sought more information on climate change than the indifference group. Family communication on global warming was positively associated with adolescents' information-seeking. Implications for interventions are discussed.

Resilience to the health risks of extreme weather events in a changing climate in the United States

Current public health strategies, policies, and measures are being modified to enhance current health protection to climate-sensitive health outcomes. These modifications are critical to decrease vulnerability to climate variability, but do not necessarily increase resilience to future (and different) weather patterns. Communities resilient to the health risks of climate change anticipate risks; reduce vulnerability to those risks; prepare for and respond quickly and effectively to threats; and recover faster, with increased capacity to prepare for and respond to the next threat. Increasing resilience includes top-down (e.g., strengthening and maintaining disaster risk management programs) and bottom-up (e.g., increasing social capital) measures, and focuses not only on the risks presented by climate change but also on the underlying socioeconomic, geographic, and other vulnerabilities that affect the extent and magnitude of impacts. Three examples are discussed of public health programs designed for other purposes that provide opportunities for increasing the capacity of communities to avoid, prepare for, and effectively respond to the health risks of extreme weather and climate events. Incorporating elements of adaptive management into public health practice, including a strong and explicit focus on iteratively managing risks, will increase effective management of climate change risks.

Climate change and health risks: assessing and responding to them through 'adaptive management'

Climate change and associated changing weather patterns, including severe weather events, are expected to increase the prevalence of a wide range of health risks. Yet there is uncertainty about the timing, location, and severity of these changes. Adaptive management, a structured process of decision making in the face of imperfect information, is an approach that can help the public health field effectively anticipate, plan for, and respond to the health risks of climate change. In this article I describe adaptive management and how it could increase the effectiveness of local and national strategies, policies, and programs to manage climate-sensitive health outcomes.

The burgeoning field of transdisciplinary adaptation research in Quebec (1998-): a climate change-related public health narrative

This paper presents a public health narrative on Quebec's new climatic conditions and human health, and describes the transdisciplinary nature of the climate change adaptation research currently being adopted in Quebec, characterized by the three phases of problem identification, problem investigation, and problem transformation. A transdisciplinary approach is essential for dealing with complex ill-defined problems concerning human-environment interactions (for example, climate change), for allowing joint research, collective leadership, complex collaborations, and significant exchanges among scientists, decision makers, and knowledge users. Such an approach is widely supported in theory but has proved to be extremely difficult to implement in practice, and those who attempt it have met with heavy resistance, succeeding when they find the occasional opportunity within institutional or social contexts. In this paper we narrate the ongoing struggle involved in tackling the negative effects of climate change in multi-actor contexts at local and regional levels, a struggle that began in a quiet way in 1998. The paper will describe how public health adaptation research is supporting transdisciplinary action and implementation while also preparing for the future, and how this interaction to tackle a life-world problem (adaptation of the Quebec public health sector to climate change) in multi-actors contexts has progressively been established during the last 13 years. The first of the two sections introduces the social context of a Quebec undergoing climate changes. Current climatic conditions and expected changes will be described, and attendant health risks for the Quebec population. The second section addresses the scientific, institutional and normative dimensions of the problem. It corresponds to a "public health narrative" presented in three phases: (1) problem identification (1998-2002) beginning in northern Quebec; (2) problem investigation (2002-2006) in which the issues are successively explored, understood, and conceptualized for all of Quebec, and (3) problem transformation (2006-2009), which discusses major interactions among the stakeholders and the presentation of an Action Plan by a central actor, the Quebec government, in alliance with other stakeholders. In conclusion, we underline the importance, in the current context, of providing for a sustained transdisciplinary adaptation to climatic change. This paper should be helpful for (1) public health professionals confronted with establishing a transdisciplinary approach to a real-world problem other than climate change, (2) professionals in other sectors (such as public safety, built environment) confronted with climate change, who wish to implement transdisciplinary adaptive interventions and/or research, and (3) knowledge users (public and private actors; nongovernment organizations; citizens) from elsewhere in multi-contexts/environments/sectors who wish to promote complex collaborations (with us or not), collective leadership, and "transfrontier knowledge-to-action" for implementing climate change-related adaptation measures.

Readying health services for climate change: a policy framework for regional development

Climate change presents the biggest threat to human health in the 21st century. However, many public health leaders feel ill equipped to face the challenges of climate change and have been unable to make climate change a priority in service development. I explore how to achieve a regionally responsive whole-of-systems approach to climate change in the key operational areas of a health service: service governance and culture, service delivery, workforce development, asset management, and financing. The relative neglect of implementation science means that policymakers need to be proactive about sourcing and developing models and processes to make health services ready for climate change. Health research funding agencies should urgently prioritize applied, regionally responsive health services research for a future of climate change.

Strategies to Strengthen Public Health Inputs to Water Policy in Response to Climate Change: An Australian Perspective

Under current climate change projections, the capacity to provide safe drinking water to Australian communities will be challenged. Part of this challenge is the lack of an adaptive governance strategy that transcends jurisdictional boundaries to support integrated policy making, regulation, or infrastructural adaptation. Consequently, some water-related health hazards may not be adequately captured or forecast under existing water resource management policies to ensure safe water supplies. Given the high degree of spatial and temporal variability in climate conditions experienced by Australian communities, new strategies for national health planning and prioritization for safe water supplies are warranted. The challenges facing public health in Australia will be to develop flexible and robust governance strategies that strengthen public health input to existing water policy, regulation, and surveillance infrastructure through proactive risk planning, adopting new technologies, and intersectoral collaborations. The proposed approach could assist policy makers avert or minimize risk to communities arising from changes in climate and water provisions both in Australia and in the wider Asia Pacific region.

Global climate change and children's health: threats and strategies for prevention

BACKGROUND

Global climate change will have multiple effects on human health. Vulnerable populations-children, the elderly, and the poor-will be disproportionately affected.

OBJECTIVE

We reviewed projected impacts of climate change on children's health, the pathways involved in these effects, and prevention strategies.

DATA SOURCES

We assessed primary studies, review articles, and organizational reports.

DATA SYNTHESIS

Climate change is increasing the global burden of disease and in the year 2000 was responsible for > 150,000 deaths worldwide. Of this disease burden, 88% fell upon children. Documented health effects include changing ranges of vector-borne diseases such as malaria and dengue; increased diarrheal and respiratory disease; increased morbidity and mortality from extreme weather; changed exposures to toxic chemicals; worsened poverty; food and physical insecurity; and threats to human habitation. Heat-related health effects for which research is emerging include diminished school performance, increased rates of pregnancy complications, and renal effects. Stark variation in these outcomes is evident by geographic region and socioeconomic status, and these impacts will exacerbate health disparities. Prevention strategies to reduce health impacts of climate change include reduction of greenhouse gas emissions and adaptation through multiple public health interventions.

CONCLUSIONS

Further quantification of the effects of climate change on children's health is needed globally and also at regional and local levels through enhanced monitoring of children's environmental health and by tracking selected indicators. Climate change preparedness strategies need to be incorporated into public health programs.

Constraints and barriers to public health adaptation to climate change: a review of the literature

Public health adaptation to climate change is an important issue and inevitably is needed to address the adverse health impacts of climate change over the next few decades. This paper provides an overview of the constraints and barriers to public health adaptation and explores future research directions in this emerging field. An extensive literature review was conducted in 2010 and published literature from 2000 to 2010 was retrieved. This review shows that public health adaptation essentially can operate at two levels, namely, adaptive-capacity building and implementation of adaptation actions. However, there are constraints and barriers to public health adaptation arising from uncertainties of future climate and socioeconomic conditions, as well as financial, technologic, institutional, social capital, and individual cognitive limits. The opportunities for planning and implementing public health adaptation are reliant on effective strategies to overcome these constraints and barriers. It is proposed here that high research priority should be given to multidisciplinary research on the assessment of potential health impacts of climate change, projections of health impacts under different climate and socioeconomic scenarios, identification of health co-benefits of mitigation strategies, and evaluation of cost-effective public health adaptation options.

Global Climate Changes and International Trade and Travel: Effects on Human Health Outcomes

There is now near-unanimous scientific agreement that greenhouse gas emissions generated by human activities have increased global temperatures and changed the earth's climate. There is, however, no universal agreement on how rapidly, regionally, or asymmetrically the earth will warm; or on the true impact of global warming on infectious disease outbreaks and natural disasters and their inevitable public health outcomes. In addition, many other factors influence the emergence and reemergence of infectious diseases in a changing environment including international trade and travel, exotic eating habits, lifestyle and residential choices, host susceptibility, and microbial adaptation. The ultimate effects of climate changes and the increased distribution of pathogens by international trade and travel will not be limited to infectious disease outbreaks in immunologically naïve populations but will also impact world food production and quality, air quality, drinking water availability and quality, immigration, urban relocation, and civil unrest. Despite the uncertainties in outcomes and their magnitudes, the active responses to climate changes in a global economy must include combinations of environmental, political, regulatory, socioeconomic, and public health measures.

Innoversity in knowledge-for-action and adaptation to climate change: the first steps of an 'evidence-based climatic health' transfrontier training program

It has become increasingly clear to the international scientific community that climate change is real and has important consequences for human health. To meet these new challenges, the World Health Organization recommends reinforcing the adaptive capacity of health systems. One of the possible avenues in this respect is to promote awareness and knowledge translation in climatic health, at both the local and global scales. Within such perspective, two major themes have emerged in the field of public health research: 1) the development of advanced training adapted to 'global environment' change and to the specific needs of various groups of actors (doctors, nurses, public health practitioners, health care managers, public service managers, local communities, etc) and 2) the development of strategies for implementing research results and applying various types of evidence to the management of public health issues affected by climate change. Progress on these two fronts will depend on maximum innovation in transdisciplinary and transsectoral collaborations. The general purpose of this article is to present the program of a new research and learning chair designed for this double set of developmental objectives - a chair that emphasizes 'innoversity' (the dynamic relationship between innovation and diversity) and 'transfrontier ecolearning for adaptive actions'. The Écoapprentissages, santé mentale et climat collaborative research chair (University of Montreal and Quebec National Public Health Institute) based in Montreal is a center for 'transdisciplinary research' on the transfrontier knowledge-for-action that can aid adaptation of the public health sector, the public mental health sector, and the public service sector to climate change, as well as a center for complex collaborations on evidence-based climatic health 'training'. This program-focused article comprises two main sections. The first section presents the 'general' and 'specific contexts' in which the chair emerged. The 'general context' pertains to the health-related challenge of finding ways to integrate, transfer, and implement knowledge, a particularly pointed challenge in Canada. The 'specific context' refers to the emerging research field of adaptation of public health to climate change. In the second section, the characteristics of the research chair are more extensively detailed (the vision of 'innoversity' and ' transfrontier knowledge-for-action,' the approach of shared responsibility and complex collaboration, objectives, and major axes of research). We conclude with a call for complex collaboration toward knowledge-for-action in public health services/mental health services/public services' adaptation to climate change: this call is aimed at individual and institutional actors in the North and South/West and East concerned by these issues.

Potential influence of climate change on vector-borne and zoonotic diseases: a review and proposed research plan

BACKGROUND

Because of complex interactions of climate variables at the levels of the pathogen, vector, and host, the potential influence of climate change on vector-borne and zoonotic diseases (VBZDs) is poorly understood and difficult to predict. Climate effects on the nonvector-borne zoonotic diseases are especially obscure and have received scant treatment.

OBJECTIVE

We described known and potential effects of climate change on VBZDs and proposed specific studies to increase our understanding of these effects. The nonvector-borne zoonotic diseases have received scant treatment and are emphasized in this paper.

DATA SOURCES AND SYNTHESIS

We used a review of the existing literature and extrapolations from observations of short-term climate variation to suggest potential impacts of climate change on VBZDs. Using public health priorities on climate change, published by the Centers for Disease Control and Prevention, we developed six specific goals for increasing understanding of the interaction between climate and VBZDs and for improving capacity for predicting climate change effects on incidence and distribution of VBZDs.

CONCLUSIONS

Climate change may affect the incidence of VBZDs through its effect on four principal characteristics of host and vector populations that relate to pathogen transmission to humans: geographic distribution, population density, prevalence of infection by zoonotic pathogens, and the pathogen load in individual hosts and vectors. These mechanisms may interact with each other and with other factors such as anthropogenic disturbance to produce varying effects on pathogen transmission within host and vector populations and to humans. Because climate change effects on most VBZDs act through wildlife hosts and vectors, understanding these effects will require multidisciplinary teams to conduct and interpret ecosystem-based studies of VBZD pathogens in host and vector populations and to identify the hosts, vectors, and pathogens with the greatest potential to affect human populations under climate change scenarios.

Evaluating the effects of ideology on public understanding of climate change science: how to improve communication across ideological divides?

While ideology can have a strong effect on citizen understanding of science, it is unclear how ideology interacts with other complicating factors, such as college education, which influence citizens' comprehension of information. We focus on public understanding of climate change science and test the hypotheses: [H1] as citizens' ideology shifts from liberal to conservative, concern for global warming decreases; [H2] citizens with college education and higher general science literacy tend to have higher concern for global warming; and [H3] college education does not increase global warming concern for conservative ideologues. We implemented a survey instrument in California's San Francisco Bay Area, and employed regression models to test the effects of ideology and other socio-demographic variables on citizen concern about global warming, terrorism, the economy, health care and poverty. We are able to confirm H1 and H3, but reject H2. Various strategies are discussed to improve the communication of climate change science across ideological divides.

Sea-level-rise disaster in Micronesia: sentinel event for climate change?

OBJECTIVES

To describe the impact of an acute-onset sea-level-rise disaster in 2 coral atoll populations and to generate hypotheses for further investigation of the association between climate change and public health.

METHODS

Households of Lukunoch and Oneop islands, Micronesia, were assessed for demographics, asset damage, food availability, water quantity and quality, hygiene and sanitation, and health status. Every fourth household on Lukunoch was randomly selected (n = 40). All Oneop households were surveyed (n = 72). Heads of each household were interviewed in the local language using a standard survey tool. Prevalence data were analyzed, and 95% confidence intervals were calculated.

RESULTS

A total of 112 total households were respondents representing 974 inhabitants. On Lukunoch, roughly half of all households surveyed reported at least a partial loss of their primary dietary staple and source of calories (taro and breadfruit). Six (15%) of 40 Lukunoch households surveyed (95% CI, 6%-30%) reported a complete loss of taro and four (10%) of the 40 households (95% CI, 3%-24%) reported a complete loss of breadfruit. On Oneop, nearly all households reported at least a partial loss of these same food staples. Twenty four (31%) of all 76 Oneop households reported a complete loss of taro and another 24 (31%) households reported a complete loss of breadfruit. One third of all households surveyed reported a complete loss. On Lukunoch 11 (28%) of 40 households, (95% CI, 15%-43%) reported damage from salination, but none were damaged to the point of a complete loss. Forty-nine (64%) of 76 Oneop households reported salination and five (6%) reported complete loss of their well.

CONCLUSION

On March 5, 2007, an acute-onset, sea level rise event resulting in coastal erosion, shoreline inundation, and saltwater intrusion occurred in two coral atoll islands of Micronesia. The findings of this study suggest that highly vulnerable populations of both islands experienced disastrous losses involving crop productivity and freshwater sources. These findings reveal the need for effective public health research and sustainable interventions that will monitor and shape the health of small island populations predicted to be at high risk for adverse health effects due to climate change.

Climate change and health in british columbia: projected impacts and a proposed agenda for adaptation research and policy

This is a case study describing how climate change may affect the health of British Columbians and to suggest a way forward to promote health and policy research, and adaptation to these changes. After reviewing the limited evidence of the impacts of climate change on human health we have developed five principles to guide the development of research and policy to better predict future impacts of climate change on health and to enhance adaptation to these change in BC. We suggest that, with some modification, these principles will be useful to policy makers in other jurisdictions.

Effectiveness of public health interventions in reducing morbidity and mortality during heat episodes: a structured review

Increasing concern over the impact of hot weather on health has fostered the development of public health interventions to reduce heat-related health impacts. However, evidence of the effectiveness of such interventions is rarely cited for justification. Our objective was to review peer-reviewed and grey literature evaluating interventions aimed at reducing morbidity and/or mortality in populations during hot weather episodes. Among studies considering public risk perceptions, most respondents were aware when an extreme heat episode was occurring but did not necessarily change their practices, primarily due to a lack of self-perception as vulnerable and confusion about the appropriate actions to be taken. Among studies of health outcomes during and following heat episodes, studies were suggestive of positive impacts in reducing morbidity and mortality. While the limited evaluative work to date suggests a positive impact of public health interventions, concern persists about whether the most vulnerable groups, like the elderly and homeless, are being adequately reached.

Assessing the vulnerability of eco-environmental health to climate change

There is an urgent need to assess the vulnerability of eco-environmental health to climate change. This paper aims to provide an overview of current research, to identify knowledge gaps, and to propose future research needs in this challenging area. Evidence shows that climate change is affecting and will, in the future, have more (mostly adverse) impacts on ecosystems. Ecosystem degradation, particularly the decline of the life support systems, will undoubtedly affect human health and wellbeing. Therefore, it is important to develop a framework to assess the vulnerability of eco-environmental health to climate change, and to identify appropriate adaptation strategies to minimize the impact of climate change.

Nonfatal natural and environmental injuries treated in emergency departments, United States, 2001-2004

Exposure to adverse natural and environmental events (eg, extreme temperatures and disasters) poses a public health burden when resulting in injuries requiring emergency care. We examined the incidence and characteristics of persons with environmental exposure-related injuries treated in US-based hospital emergency departments during 2001 to 2004 by using the National Electronic Injury Surveillance System-All Injury Program. An estimated 26 527 (95% CI = 18 664-34 390) injuries were treated annually-78% were heat-related. People with heat-related conditions were men (P < 0.001) and had a median age of 34 years (range = <1 month-94 years). Targeting vulnerable populations in community-wide response measures may reduce injuries from adverse environmental exposures, especially heat.

Public Health Responses to Climate Change Health Impacts in Indonesia

Although climate change is a global concern, there are particular considerations for Indonesia as an archipelagic nation. These include the vulnerability of people living in small islands and coastal areas to rising sea levels; the expansion of the important mosquito-borne diseases, particularly malaria and dengue, into areas that lack of immunity; and the increase in water-borne diseases and malnutrition. This article proposes a set of public health responses to climate change health impacts in Indonesia. Some important principles and practices in public health are highlighted, to develop effective public health approaches to climate change in Indonesia.

The future of epidemiology

In this article, the authors discuss current challenges and opportunities in epidemiology that will affect the field's future. Epidemiology is commonly considered the methodologic backbone for the fields of public health and outcomes research because its practitioners describe patterns of disease occurrence, identify risk factors and etiologic determinants, and demonstrate the usefulness of interventions. Like most aspects of science, epidemiology is in rapid flux. Several factors that are influencing and will continue to influence epidemiology and the health of the public include factors fundamental to framing the discipline of epidemiology (i.e., its means of communication, its methodologies, its access to data, its values, its population perspective), factors relating to scientific advances (e.g., genomics, comparative effectiveness in therapeutics), and factors shaping human health (e.g., increasing globalism, the environment, disease and lifestyle, demographics, infectious disease).

Environmental health indicators of climate change for the United States: findings from the State Environmental Health Indicator Collaborative

OBJECTIVE

To develop public health adaptation strategies and to project the impacts of climate change on human health, indicators of vulnerability and preparedness along with accurate surveillance data on climate-sensitive health outcomes are needed. We researched and developed environmental health indicators for inputs into human health vulnerability assessments for climate change and to propose public health preventative actions.

DATA SOURCES

We conducted a review of the scientific literature to identify outcomes and actions that were related to climate change. Data sources included governmental and nongovernmental agencies and the published literature.

DATA EXTRACTION

Sources were identified and assessed for completeness, usability, and accuracy. Priority was then given to identifying longitudinal data sets that were applicable at the state and community level.

DATA SYNTHESIS

We present a list of surveillance indicators for practitioners and policy makers that include climate-sensitive health outcomes and environmental and vulnerability indicators, as well as mitigation, adaptation, and policy indicators of climate change.

CONCLUSIONS

A review of environmental health indicators for climate change shows that data exist for many of these measures, but more evaluation of their sensitivity and usefulness is needed. Further attention is necessary to increase data quality and availability and to develop new surveillance databases, especially for climate-sensitive morbidity.

Impact of drainage networks on cholera outbreaks in Lusaka, Zambia

OBJECTIVES

We investigated the association between precipitation patterns and cholera outbreaks and the preventative roles of drainage networks against outbreaks in Lusaka, Zambia.

METHODS

We collected data on 6542 registered cholera patients in the 2003-2004 outbreak season and on 6045 cholera patients in the 2005-2006 season. Correlations between monthly cholera incidences and amount of precipitation were examined. The distribution pattern of the disease was analyzed by a kriging spatial analysis method. We analyzed cholera case distribution and spatiotemporal cluster by using 2590 cholera cases traced with a global positioning system in the 2005-2006 season. The association between drainage networks and cholera cases was analyzed with regression analysis.

RESULTS

Increased precipitation was associated with the occurrence of cholera outbreaks, and insufficient drainage networks were statistically associated with cholera incidences.

CONCLUSIONS

Insufficient coverage of drainage networks elevated the risk of cholera outbreaks. Integrated development is required to upgrade high-risk areas with sufficient infrastructure for a long-term cholera prevention strategy.

Preventing heat-related morbidity and mortality: new approaches in a changing climate

Due to global climate change, the world will, on average, experience a higher number of heat waves, and the intensity and length of these heat waves is projected to increase. Knowledge about the implications of heat exposure to human health is growing, with excess mortality and illness occurring during hot weather in diverse regions. Certain groups, including the elderly, the urban poor, and those with chronic health conditions, are at higher risk. Preventive actions include: establishing heat wave warning systems; making cool environments available (through air conditioning or other means); public education; planting trees and other vegetation; and modifying the built environment to provide proper ventilation and use materials and colors that reduce heat build-up and optimize thermal comfort. However, to inspire local prevention activities, easily understood information about the strategies' benefits needs to be incorporated into decision tools. Integrating heat health information into a comprehensive adaptation planning process can alert local decision-makers to extreme heat risks and provide information necessary to choose strategies that yield the largest health improvements and cost savings. Tools to enable this include web-based programs that illustrate effective methods for including heat health in comprehensive local-level adaptation planning; calculate costs and benefits of several activities; maps showing zones of high potential heat exposure and vulnerable populations in a local area; and public awareness materials and training for implementing preventive activities. A new computer-based decision tool will enable local estimates of heat-related health effects and potential savings from implementing a range of prevention strategies.

Climate change and emergency medicine: impacts and opportunities

There is scientific consensus that the climate is changing, that human activity plays a major role, and that the changes will continue through this century. Expert consensus holds that significant health effects are very likely. Public health and health care systems must understand these impacts to properly pursue preparedness and prevention activities. All of medicine will very likely be affected, and certain medical specialties are likely to be more significantly burdened based on their clinical activity, ease of public access, public health roles, and energy use profiles. These specialties have been called on to consider the likely impacts on their patients and practice and to prepare their practitioners. Emergency medicine (EM), with its focus on urgent and emergent ambulatory care, role as a safety-net provider, urban concentration, and broad-based clinical mission, will very likely experience a significant rise in demand for its services over and above current annual increases. Clinically, EM will see amplification of weather-related disease patterns and shifts in disease distribution. In EM's prehospital care and disaster response activities, both emergency medical services (EMS) activity and disaster medical assistance team (DMAT) deployment activities will likely increase. EM's public health roles, including disaster preparedness, emergency department (ED)-based surveillance, and safety-net care, are likely to face increasing demands, along with pressures to improve fuel efficiency and reduce greenhouse gas emissions. Finally, EM's roles in ED and hospital management, particularly related to building and purchasing, are likely to be impacted by efforts to reduce greenhouse gas emissions and enhance energy efficiency. Climate change thus presents multiple clinical and public health challenges to EM, but also creates numerous opportunities for research, education, and leadership on an emerging health issue of global scope.

Use of computer modeling for emergency preparedness functions by local and state health officials: a needs assessment

The authors, collaborating from several public health institutes, present the methodology, results, and lessons learned from a multistate needs assessment of local and state public health and safety officials regarding their familiarity and use of formal computer modeling for preparedness activities. The study was undertaken to provide information to the newly formed Preparedness Modeling Unit within the Centers for Disease Control and Prevention. The focus was on the use of sophisticated mathematical models associated with three public health threats: pandemic influenza, radiologic release, and severe heat waves. The use of computer modeling and scenario-based analyses can be used to better frame problems and opportunities, integrate data sources, expect outcomes, and improve multistakeholder decision making. The results of the eight state needs assessment demonstrated that preparedness officials are familiar with models and would use computer modeling as a tool, along with other tools and general experiences, depending upon the perceived quality and validity of the model and the assumptions, as well as the applicability, of the model to their particular setting and population. More needs to be done to improve awareness and dissemination of available models and share best practices in both knowledge and use of models. Use of preparedness modeling would enhance the planning for vulnerable and at-risk populations, all-hazard emergencies and infectious disease containment strategies, as well as for response functions including evacuation, sheltering, quarantine, and distribution of medications and supplies.

Potential impact of climate change on air pollution-related human health effects

The potential health impact of ambient ozone and PM2.5 concentrations modulated by climate change over the United States is investigated using combined atmospheric and health modeling. Regional air quality modeling for 2001 and 2050 was conducted using CMAQ Modeling System with meteorology from the GISS Global Climate Model, downscaled regionally using MM5,keeping boundary conditions of air pollutants, emission sources, population, activity levels, and pollution controls constant. BenMap was employed to estimate the air pollution health outcomes at the county, state, and national level for 2050 caused by the effect of meteorology on future ozone and PM2.5 concentrations. The changes in calculated annual mean PM2.5 concentrations show a relatively modest change with positive and negative responses (increasing PM2.5 levels across the northeastern U.S.) although average ozone levels slightly decrease across the northern sections of the U.S., and increase across the southern tier. Results suggest that climate change driven air quality-related health effects will be adversely affected in more then 2/3 of the continental U.S. Changes in health effects induced by PM2.5 dominate compared to those caused by ozone. PM2.5-induced premature mortality is about 15 times higher then that due to ozone. Nationally the analysis suggests approximately 4000 additional annual premature deaths due to climate change impacts on PM2.5 vs 300 due to climate change-induced ozone changes. However, the impacts vary spatially. Increased premature mortality due to elevated ozone concentrations will be offset by lower mortality from reductions in PM2.5 in 11 states. Uncertainties related to different emissions projections used to simulate future climate, and the uncertainties forecasting the meteorology, are large although there are potentially important unaddressed uncertainties (e.g., downscaling, speciation, interaction, exposure, and concentration-response function of the human health studies).

Climate change and infectious diseases in Europe

Concerted action is needed to address public health issues raised by climate change. In this Review we discuss infections acquired through various routes (arthropod vector, rodent, water, food, and air) in view of a changing climate in Europe. Based on an extensive review of published work and expert workshops, we present an assessment of the infectious disease challenges: incidence, prevalence, and distribution are projected to shift in a changing environment. Due to the high level of uncertainty on the rate of climate change and its impact on infectious diseases, we propose to mount a proactive public health response by building an integrated network for environmental and epidemiological data. This network would have the capacity to connect epidemic intelligence and infectious disease surveillance with meteorological, entomological, water quality, remote sensing, and other data, for multivariate analyses and predictions. Insights from these analyses could then guide adaptation strategies and protect population health from impending threats related to climate change.

U.S. Funding is insufficient to address the human health impacts of and public health responses to climate variability and change

BACKGROUND

The need to identify and try to prevent adverse health impacts of climate change has risen to the forefront of climate change policy debates and become a top priority of the public health community. Given the observed and projected changes in climate and weather patterns, their current and anticipated health impacts, and the significant degree of regulatory discussion underway in the U.S. government, it is reasonable to determine the extent of federal investment in research to understand, avoid, prepare for, and respond to the human health impacts of climate change in the United States.

OBJECTIVE

In this commentary we summarize the health risks of climate change in the United States and examine the extent of federal funding devoted to understanding, avoiding, preparing for, and responding to the human health risks of climate change.

DISCUSSION

Future climate change is projected to exacerbate various current health problems, including heat-related mortality, diarrheal diseases, and diseases associated with exposure to ozone and aeroallergens. Demographic trends and geophysical and socioeconomic factors could increase overall vulnerability. Despite these risks, extramural federal funding of climate change and health research is estimated to be < $3 million per year.

CONCLUSIONS

Given the real risks that climate change poses for U.S. populations, the National Institutes of Health, Centers for Disease Control and Prevention, U.S. Environmental Protection Agency, and other agencies need to have robust intramural and extramural programs, with funding of > $200 million annually. Oversight of the size and priorities of these programs could be provided by a standing committee within the National Academy of Sciences.

Health professionals' roles in animal agriculture, climate change, and human health

What we eat is rapidly becoming an issue of global concern. With food shortages, the rise in chronic disease, and global warming, the impact of our dietary choices seems more relevant today than ever. Globally, a transition is taking place toward greater consumption of foods of animal origin, in lieu of plant-based diets. With this transition comes intensification of animal agriculture that in turn is associated with the emergence of zoonotic infectious diseases, environmental degradation, and the epidemics of chronic disease and obesity. Health professionals should be aware of these trends and consider them as they promote healthier and more environmentally-sustainable diets.

The 2006 California heat wave: impacts on hospitalizations and emergency department visits

BACKGROUND

Climate models project that heat waves will increase in frequency and severity. Despite many studies of mortality from heat waves, few studies have examined morbidity.

OBJECTIVES

In this study we investigated whether any age or race/ethnicity groups experienced increased hospitalizations and emergency department (ED) visits overall or for selected illnesses during the 2006 California heat wave.

METHODS

We aggregated county-level hospitalizations and ED visits for all causes and for 10 cause groups into six geographic regions of California. We calculated excess morbidity and rate ratios (RRs) during the heat wave (15 July to 1 August 2006) and compared these data with those of a reference period (8-14 July and 12-22 August 2006).

RESULTS

During the heat wave, 16,166 excess ED visits and 1,182 excess hospitalizations occurred statewide. ED visits for heat-related causes increased across the state [RR = 6.30; 95% confidence interval (CI), 5.67-7.01], especially in the Central Coast region, which includes San Francisco. Children (0-4 years of age) and the elderly (> or = 65 years of age) were at greatest risk. ED visits also showed significant increases for acute renal failure, cardiovascular diseases, diabetes, electrolyte imbalance, and nephritis. We observed significantly elevated RRs for hospitalizations for heat-related illnesses (RR = 10.15; 95% CI, 7.79-13.43), acute renal failure, electrolyte imbalance, and nephritis.

CONCLUSIONS

The 2006 California heat wave had a substantial effect on morbidity, including regions with relatively modest temperatures. This suggests that population acclimatization and adaptive capacity influenced risk. By better understanding these impacts and population vulnerabilities, local communities can improve heat wave preparedness to cope with a globally warming future.

The built environment, climate change, and health: opportunities for co-benefits

The earth's climate is changing, due largely to greenhouse gas emissions resulting from human activity. These human-generated gases derive in part from aspects of the built environment such as transportation systems and infrastructure, building construction and operation, and land-use planning. Transportation, the largest end-use consumer of energy, affects human health directly through air pollution and subsequent respiratory effects, as well as indirectly through physical activity behavior. Buildings contribute to climate change, influence transportation, and affect health through the materials utilized, decisions about sites, electricity and water usage, and landscape surroundings. Land use, forestry, and agriculture also contribute to climate change and affect health by increasing atmospheric levels of carbon dioxide, shaping the infrastructures for both transportation and buildings, and affecting access to green spaces. Vulnerable populations are disproportionately affected with regard to transportation, buildings, and land use, and are most at risk for experiencing the effects of climate change. Working across sectors to incorporate a health promotion approach in the design and development of built environment components may mitigate climate change, promote adaptation, and improve public health.

Climate change: the importance of place

Climate change-related risks are place-specific and path-dependent. Accordingly, location is an important determinant of hazardous exposure, and certain places will bear more risk than others. This article reviews the major environmental exposures associated with risky places in the U.S., including coastal regions, islands, the desert Southwest, vectorborne and zoonotic disease border regions, cities, and the U.S. Arctic (Alaska), with emphasis on exposures and vulnerable populations of concern. In addition to these hotspots, this study considers the ways in which the concept of place--the sense of human relationship with particular environments--will play a key role in motivating, developing, and deploying an effective public health response. In considering the importance of place, we highlight the concepts of community resilience and risk management, key aspects of a robust response to climate change in public health and other sectors.

Climate change: impacts on and implications for global health

The most severe consequences of climate change will accrue to the poorest people in the poorest countries, despite their own negligible contribution to greenhouse gas emissions. In recent years, global health efforts in those same countries have grown dramatically. However, the emerging scientific consensus about climate change has not yet had much influence on the routine practice and strategies of global health. We review here the anticipated types and global distribution of health impacts of climate change, discuss relevant aspects of current global interventions for health in low-income countries, and consider potential elements of a framework for appropriately and efficiently mainstreaming global climate change-mitigation and -adaptation strategies into the ongoing enterprise of global health. We propose a collaborative learning initiative involving four areas: (1) increased awareness among current global health practitioners of climate change and its potential impacts for the most disadvantaged, (2) strengthening of the evidence base, (3) incorporation now of climate change-mitigation and -adaptation concerns into design of ongoing global health programs, and (4) alignment of current global health program targets and methods with larger frameworks for climate change and sustainable development. The great vulnerability to climate change of populations reached by current global health efforts should prompt all concerned with global health to take a leading role in advocating for climate change mitigation in their own countries.

Community-based adaptation to the health impacts of climate change

The effects of and responses to the health impacts of climate change will affect individuals, communities, and societies. Effectively preparing for and responding to current and projected climate change requires ongoing assessment and action, not a one-time assessment of risks and interventions. To promote resilience to climate change and other community stressors, a stepwise course of action is proposed for community-based adaptation that engages stakeholders in a proactive problem solving process to enhance social capital across local and national levels. In addition to grassroots actions undertaken at the community level, reducing vulnerability to current and projected climate change will require top-down interventions implemented by public health organizations and agencies.